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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: C) TIME� CASE t#: Is — <br />LOCATION (PARK/OPEN SPACE): CIII 4r5 Ilr+ _t <br />z <br />Name: Last First Middle <br />r\Q III <br />DOB: <br />Rae -/'Sex <br />Res. Address: City <br />rstl7t, <br />Zip <br />Res, Phone: <br />Work Phone: <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on you violated SectionA --- C__( 4 I the Park <br />This restriction of use is effective beginning on and shall remain in effect until <br />I _CE <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice, A request for an <br />info: mal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402, <br />SlIVC L11 WMKU1lUb) III JC Ull Lilt; luqucsf LQ1 IlUdllllg IAL 1.11C 111101111di 11CU1111g, wc 1JIVIslull "tICULL?i Will U <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing, <br />This Notice shall remain in effeet pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature of person ,,Id elvering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy Report Copy Pink C opy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />